- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $633.47 / $2,747.00 / $5,454.00
| Facility | | $633.47 | $2,747.00 | $5,454.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $633.47 / $1,093.47 / $2,535.60
| Professional | | $633.47 | $1,093.47 | $2,535.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $818.35 / $3,960.00 / $17,199.04
| Facility | | $818.35 | $3,960.00 | $17,199.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $932.05 / $1,667.01 / $11,743.32
| Professional | | $932.05 | $1,667.01 | $11,743.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,086.93 / $1,788.00 / $2,364.83
| Professional | | $1,086.93 | $1,788.00 | $2,364.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,332.00 / $1,957.70 / $3,479.34
| Professional | | $1,332.00 | $1,957.70 | $3,479.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $929.25 / $1,909.00 / $6,679.00
| Facility | | $929.25 | $1,909.00 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,095.00 / $1,347.41 / $2,409.08
| Professional | | $1,095.00 | $1,347.41 | $2,409.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,179.24 / $2,237.02 / $2,937.02
| Professional | | $1,179.24 | $2,237.02 | $2,937.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $7,157.00 / $17,462.00
| Facility | | $55.00 | $7,157.00 | $17,462.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,249.77 / $1,890.16 / $11,743.32
| Professional | | $1,249.77 | $1,890.16 | $11,743.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,540.00 / $7,157.00 / $14,101.00
| Facility | | $2,540.00 | $7,157.00 | $14,101.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,152.27 / $1,597.85 / $4,184.89
| Professional | | $1,152.27 | $1,597.85 | $4,184.89 |